Our Death Toll Is Incomprehensible, How Do We Cope?
A hospice social worker’s advice on how to process
Everyone dies — and yet, no one wants to talk about that. Even as we continue to find ourselves in a pandemic with a death toll so destabilizing, so different from the familiar I face as a hospice and palliative care social worker. We’re dying, and we’re grieving, and there is no end in sight. I write this as a call to soothe — to offer a space to this grim, untranslatable experience.
In my work, I have witnessed thousands of deaths over the past 21 years — all within a 30-mile radius of Los Angeles. I have sat with those in transition and those who have just died. I have calmed patients and families in crisis. I have joined with centenarians, babies, children, teens, adults, brand-new parents, veterans, newlyweds, Holocaust and internment camp survivors, the newly retired, political leaders, celebrities, royalty, doctors, CEOs, artists, healers, musicians, and hermits.
One thing I know is that death is in the back of our minds constantly — but we rarely allow ourselves to think of it consciously. Despite the fact that we will all eventually experience death, the dying are one of the most underrepresented populations. We don’t speak their realities, we don’t convey their perspectives.
Covid-19 has changed that for many of us. As the world staggers through a global pandemic, the magnitude of which hasn’t been seen in a century, death is suddenly an everyday, top-of-mind experience. Each of the 200,000+ U.S. Covid-19 deaths and counting has affected dozens, and sometimes hundreds, of people who love them. The impact is oceanic.
For a society so uncomfortable cohabitating with death, how do we process this sudden confrontation with death and dying?
I’d like to share some of what I’ve learned in my two decades of this work, as a kind of field guide for death in a pandemic. What follows are tools for Covid-19 patients and their families to begin to reconfigure and transform loss — something I believe we are all in need of.
1. Covid-19 death is different
Normally, I tell people that there are no accurate images of death and dying in the movies. The scenes predominantly show only last breaths. The last breath is just that — a final moment. It is not the dying process that spans many weeks and months. Also very inaccurate are the scenes of people talking as they are dying. When a person is in a death transition, typically they are unresponsive hours to days before their last breath. Death is generally a gradual process and it is deeply personal. Much like no two labors are the same, neither are two deaths. But in the time of Covid-19, people are dying suddenly, with very little warning. It’s akin to becoming pregnant and having the baby all in a span of six days. Many deaths are sudden events — which is destabilizing on both a personal and societal level.
Sudden death produces traumatic bereavement, which shatters our basic assumptions about a world we once believed was predictable, controllable, meaningful, and based on principles of fairness and justice. The normal dying experience has a built-in process of seeing, feeling, and integrating expected loss so that by the time a person is almost ready to leave their body, we begin to be ready in a way that without such a process, we would not be.
For a society so uncomfortable cohabitating with death, how do we process this sudden confrontation with death and dying?
2. Allow virtual presence to be enough
Covid-19 deaths happen mostly in isolation. How can you connect to someone you cannot visit or who is non-verbal? Families often tell me that by the time they are allowed to see their dying loved one over a screen, there are turbulent mechanical noises present as well and the face they see is mostly unable to connect with theirs. I realize this might (understandably) feel like a punch in the gut, but I offer the following practice as a way to tolerate and understand it: Ask the discouraging mind noise to go. In other words, as a practice of accepting the current heartbreaking limitations, try to redirect your thinking to what is happening right now.
I focus my attention on connecting empathetically to the dying and their families. I imagine all who are caring for the dying person to be extensions of the loved one. Above all, I know that joining my mind and heart to theirs is a way through. The idea that one can connect virtually can melt some of the physical separation (if we let it). Acceptance of a difficult situation is not approval of that situation. The more we can allow ourselves to accept, we can still simultaneously hold feelings of grief, love, powerlessness, and sadness.
3. Existential suffering may only be calmed in moments
The psychological first aid needed for the dying and their loved ones is found mostly in moments. Years ago, my father’s childhood friend was suddenly dying and on life support. Despite the fact that I had shared stories with my father for decades about my work with the dying, he asked me: “ Should I go see him? What can I say? What would I do?” In an instant, my dad was weepy while my mind swept over literally countless conversations we had had on this very topic. Had he been listening? But this was different. He wasn’t just in the listening position now — he was charged with being with his dying friend. Despite all we can learn from end of life experts, the being with is experiential. There is no string of words that can calm the loss that comes with death or dying.
For the living, death often feels like free-falling: We are untethered, anxious, powerless. But there can be moments of serenity — often separated by periods of doubt and anxiety — that soothe both our loved ones and us. Knowing this releases us from trying to tame the loss with talking or doing. Instead, I focus on the awareness that there are inner resources available for all of us in times of great shock or suffering and that they are so potent that they can only be experienced as brief moments. We don’t have to say the actual word goodbye, especially if it doesn’t feel organic or like what would comfort us or the dying person. We can talk about our love or life instead. We can play music or share in silence. When we are born, our strongest sense is our hearing and when we die, the same is true. I believe that we hear what we are meant to hear as we are dying — although we are often unable to respond.
4. Covid-19 produces complicated grief
When we are unable to bear witness to the moment that is often associated with dying — someone’s last breath — it can render the loss much harder to accept and process. This often complicates grieving. Our reality is shifting faster than we can adjust to, we are in shock, we may feel out of our body and like we have been robbed of necessary, painful clarity.
When our loved one dies suddenly, our grief is traumatic and complicated and our period of grief and dysregulation is often extended. Many family members must process distressing, blameless transmission stories. What’s more, the private experience of loss and bereavement is compounded by ever-present signs of the pandemic. We can’t escape the news and how the world is operating in a whole new way. We can’t escape those wearing masks and those who are not.
I facilitate a Covid-19 bereavement group and recently spoke with a daughter of eight children who unknowingly infected her dad. The complexity of feelings within just that one family system is bewildering. Multiply this by 200,000+ deaths and we can imagine a kind of national (global) disaster that triggers traumatic societal bereavement, not only for our neighbors and fellows, but also for the way of life we once took for granted.
In the time of Covid-19, people are dying suddenly, with very little warning. It’s akin to becoming pregnant and having the baby all in a span of six days.
5. It’s a time for healing, not curing
Healing means to make whole, not to eradicate a condition. Healing is an integrative process that can transcend some of our most devastating experiences. Many of us experience our first real awareness of the separation of ourselves from our bodies in the dying process. That can initiate an existential crisis. But in this immense vulnerability we can also establish or deepen relationships, tapping into unlimited mysterious possibilities.
Amazingly, I have never met someone who didn’t feel ready to die. Sometimes it happens at the onset of diagnosis and sometimes it happens days from their last breath, because dying is a whole other life stage. We are born to one day leave our bodies. There is a type of emotional cocoon a human being enters when we die: We fall inward, sleep more, and are comforted by stillness. This time is marked by states of unresponsiveness. For all of us facing loss, we may be asking or feeling, who is the me that I am becoming — will become — without this someone I love? Those of us left behind face something like healing after a forest fire: growth and integration will arrive but nothing will ever be the same.
6. Dying is the ultimate connection to the moment
When I am of service to those in their dying process — and especially to friends or family members of the dying — I try to move past rational or logical thinking and into the state of immediate felt experience. My goal is to enter the moment with them. In the moment, there is a freedom from needing to understand — a freedom from attachment or need for the condition to change. There is only what’s happening now — no matter how painful.
My hope is that this field guide can give all of us a moment to see, and reflect on, death and dying in new, more conscious ways — so that we may experience these shocking, complicated, hard days in a way that draws us closer together.
